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研究生:蔡沂芯
研究生(外文):TSAI, I-HSIN
論文名稱:輪班勞工之日夜作息型態與飲食之相關
論文名稱(外文):Chronotype and dietary quality in shift workers.
指導教授:李美璇李美璇引用關係
指導教授(外文):LEE, MEEI-SHYUAN
口試委員:黃怡真王鐘慶李美璇
口試委員(外文):HUANG, YI-CHENWANG, CHUNG-CHINGLEE, MEEI-SHYUAN
口試日期:2019-05-14
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:130
中文關鍵詞:晝夜節律日夜作息型態輪班飲食品質分數ODI-R
外文關鍵詞:Circadian rhythmChronotypeShift-workDietary quality scoreODI-R
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現代社會,輪班人口愈來愈多。輪班可能會破壞人體內之晝夜節律,與不良的健康問題(如:肥胖、糖尿病及癌症等)有關。研究顯示輪班者傾向攝取較多高油高糖食物,並且攝取較少蔬果及相關營養素。個體有屬於自己的晝夜節律,稱為「日夜作息型態」(chronotype)此差異可被測量及分類成清晨型至夜晚型。相較於清晨型,夜晚型有較多不健康行為(如:吸菸、體能活動較少及睡眠品質較差)並攝取較不健康之食物。本研究之目的為探討輪班勞工之日夜作息型態與其飲食品質之相關性,勞工之日夜作息型態與飲食品質是否有關?以及勞工之日夜作息型態與飲食品質之關係是否會受輪班影響?
本論文為一橫斷性研究,在2018年4月至10月期間,於三軍總醫院健康管理中心招募有工作的受檢者(20-70歲)500位,排除條件不符者,共416位納入分析。以清晨型和夜晚型問卷自評量表(MEQ-SA)為研究工具,分別算出MEQ分數,將日夜作息型態由分數低至高依序分為夜晚型、中間型及清晨型,共三型。再以食物頻率問卷(FFQ)蒐集個案過去一個月的飲食,並根據衛生署「每日飲食指南」及「國民飲食指標」,將FFQ轉換成飲食品質分數,本論文使用全面飲食指標修正版(ODI-R),包含9個項目,總分介於0-100分,分數愈高,代表飲食品質愈好。並以問卷收集參與者之人口學及行為資料。
參與者之日夜作息型態分布為:清晨型26.0%、中間型62.2%及夜晚型11.8%,清晨型較多男性、年齡較高;菸、酒、檳榔之使用、輪班工作、輪班年資及喝飲料習慣比例較低。控制其它變項後,清晨型的ODI-R仍顯著高於中間型2.77分(p=0.026)。
然而,輪班與否與日夜作息型態具有交互作用(p=0.035),若分為輪班與否,輪班者之清晨型ODI-R較夜晚型高,非輪班者則為夜晚型ODI-R優於清晨型,故勞工之日夜作息型態與飲食品質之關係會受輪班與否影響。輪班者與整體族群相同,清晨型之ODI-R較夜晚型佳,然探究非輪班者之ODI-R與假設恰為相反之原因,可能為非輪班者之夜晚型多為醫療人員,其知識水準與飲食觀念可能較佳,抑或是其他未被收集之因素。
本研究結論為整體而言夜晚型勞工之飲食品質較清晨型差,其差異來自全榖、蛋豆魚肉類、黃豆製品、蔬菜、水果、膽固醇及飲食多樣性。輪班與否為日夜作息型態與飲食品質之間的影響因子。輪班者,夜晚型之飲食品質較差;然非輪班者,夜晚型之飲食品質較佳。本研究之年輕勞工ODI-R分數皆不高,平均約略在60至70 分之間,在黃豆製品、魚類、奶類、水果及飲食多樣性表現不甚理想,若要提高飲食品質,可以從這幾類食物著手。相信在提高黃豆製品、魚類、奶類及水果攝取後,飲食多樣性勢必會提升。

Background: Nowadays, there are more and more shift workers. Shift-works may disrupt the circadian rhythms in body and are associated with poor health problems such as obesity, diabetes and cancer. Studies have shown that shift workers tend to consume more high-fat, high-sugar foods and less fruits, vegetables and related nutrients. Individuals have their own circadian rhythms, called "chronotype". These differences can be measured and classified into morning type to evening type. Compared with morning type, evening type has more unhealthy behaviors (such as smoking, less physical activity and poor sleep quality) and consumes less healthy food.
Aim: To investigate the relation between chronotypes and dietary quality in shift workers. Are chronotypes of workers related to dietary quality? And is the relationship between chronotypes of the workers and diet quality affected by shift-work?
Study design: Cross-sectional study.
Methods: From April to October 2018, 500 subjects (20-70 years old) who were recruited in the Tri-Service General Hospital Health Management Center. Excluding the exclusion criteria, 416 were included in the study. They were studied using self-administered questionnaires. The questionnaires covered demographic characteristics, behavioral data, Morningness-Eveningness Questionnaire Self-Assessment (MEQ-SA) and Food Frequency Questionnaire (FFQ). The MEQ scores were calculated. Chronotypes were divided into eveningness type, neither type and morning type from low score to high score. The FFQ was used to collect the diet of the past month. According to the Department of Health's "Dietary Guidelines" and "National Dietary Indicators", the FFQ was converted into a dietary quality score. We use Overall Dietary Index-Revised (ODI-R), containing 9 items, with a total score of 0-100. The higher the score, the better the quality of the diet.
Results: Chronotype patterns: Morning type 26.0%, neither type 62.2% and evening type 11.8%. More men and older ages; the use of tobacco, alcohol, betel nut, shift work, shift years and drinking beverages were lower in the morning type. After controlling other variables, ODI-R of morning type was still significantly higher than neither type of 2.77 points (p=0.026). However, shift-work had an interaction with chronotypes (p=0.035). If it was divided into shift-work or not, ODI-R of morning type in shift workers was higher than evening type, while ODI-R of morning type in non-shift workers was lower than evening type. Therefore, the relationship between chronotypes and diet quality would be affected by the shift-work. The shift workers were the same as the overall group. ODI-R in morning type was better than evening type. However, the ODI-R of non-shift workers was opposite. The reason may be that the non-shift workers in evening type were more medical personnel. Their knowledge of diet may be better, or other factors were not collected.
Conclusions: The overall diet quality of evening type was worse than morning type. The difference comes from the whole gram, egg, fish, meat, soybean products, vegetables, fruits, cholesterol and diet diversity score. Shift-work was the influence factor between chronotypes and diet quality. For shift workers, the diet quality in evening type was poor; however, those who were non-shift workers had a better diet quality in evening type. ODI-R of these young participants in this study were not high, the average ODI-R was about 60 to 70 points. The performance of soybean products, fish, milk, fruits and diet diversity score was not as good as the suggestion. To improve the dietary quality, they can start with these types of food. It is believed that after increasing the intake of soybean products, fish, milk and fruits, the diet diversity score will inevitably increase.

第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 晝夜節律 5
第二節 日夜作息型態(CHRONOTYPE)之影響因子 10
第三節 日夜作息型態(CHRONOTYPE)與營養因子之探討 14
第四節 飲食評量指標 18
第三章 研究問題與假設 29
第一節 研究問題 29
第二節 研究假設 29
第四章 研究架構與方法 30
第一節 研究架構 30
第二節 研究設計與研究對象 31
第三節 研究工具 33
第四節 資料處理 37
第五節 統計方法 41
第五章 結果 43
第一節 研究族群基本資料分布 43
第二節 研究族群之飲食品質分布 57
第六章 討論 67
第一節、日夜作息型態之分布情形 67
第二節、日夜作息型態與飲食品質之關係 71
第三節 研究限制 74
第七章 結論 77
第八章 參考文獻 78


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